Force of habit: shrubs, trees and contingent evolution of wood anatomical diversity using Croton (Euphorbiaceae) as a model system.

Background and Aims: Wood is a major innovation of land plants, and is usually a central component of the body plan for two major plant habits: shrubs and trees. Wood anatomical syndromes vary between shrubs and trees, but no prior work has explicitly evaluated the contingent evolution of wood anatomical diversity in the context of these plant habits. Methods: Phylogenetic comparative methods were used to test for contingent evolution of habit, habitat and wood anatomy in the mega-diverse genus Croton (Euphorbiaceae), across the largest and most complete molecular phylogeny of the genus to date. Key Results: Plant habit and habitat are highly correlated, but most wood anatomical features correlate more strongly with habit. The ancestral Croton was reconstructed as a tree, the wood of which is inferred to have absent or indistinct growth rings, confluent-like axial parenchyma, procumbent ray cells and disjunctive ray parenchyma cell walls. The taxa sampled showed multiple independent origins of the shrub habit in Croton , and this habit shift is contingent on several wood anatomical features (e.g. similar vessel-ray pits, thick fibre walls, perforated ray cells). The only wood anatomical trait correlated with habitat and not habit was the presence of helical thickenings in the vessel elements of mesic Croton . Conclusions: Plant functional traits, individually or in suites, are responses to multiple and often confounding contexts in evolution. By establishing an explicit contingent evolutionary framework, the interplay between habit, habitat and wood anatomical diversity was dissected in the genus Croton . Both habit and habitat influence the evolution of wood anatomical characters, and conversely, the wood anatomy of lineages can affect shifts in plant habit and habitat. This study hypothesizes novel putatively functional trait associations in woody plant structure that could be further tested in a variety of other taxa.

Verrucous carcinoma of the oral mucosa: an epidemiological and follow-up study of patients treated with surgery in 5 last years.

INTRODUCTION: Oral Verrucous Carcinoma (OVC) is described apart of the Squamous Cell Carcinoma (SCC) due to its specific properties. The objective of our study is to show our series of cases of OVC and to compare with the SCC in terms of clinical manifestations, epidemiology, histopathology, treatment and follow-up. MATERIAL AND METHODS: This is a retrospective study of all the OVC treated in our department between January-2007 and December-2011. The analyzed variables were sex, age, localization in the oral cavity, histopathology, number of biopsies needed to diagnose OVC, TNM classification, treatment and recurrences during follow-up. RESULTS: Our sample was composed by n=14 patients, 57% female, with a mean age of 69.14 years. The most common localization was buccal mucosa (n=5). Seven patients were diagnosed of OVC with the first biopsy. TNM classification was: pT1: 7 patients, pT2: 3 patients, pT3: 3 patients, pT4: 1 patient. No cervical metastases were observed either in cervical neck dissection or during the follow-up of the patients. The treatment was surgery with clinical resection margins up to 1 cm in all cases, followed by radiotherapy in selected cases. Only n=1 patient (7.69%) presented a recurrence after 34 months of follow-up. The overall survival rate was 92.85%. CONCLUSIONS: In our population, OVC represents the 6.16% of all oral cavity and oropharynx cancer, and is more frequent in female patients above 70 years old. It uses to rise over a previous lesion, and usually affects the buccal mucosa. In patients with high suspicious lesions, more than one biopsy may be needed to diagnose OVC. No patient showed cervical dissemination. In our experience, treatment based on local resection, without cervical neck dissection, could be a good option for these patients.

Chondromyxoid fibroma affecting the maxilla in a 1-year-old child: Immunohistochemical analysis and literature review.

Chondromyxoid fibroma (CMF) is a benign chondroid/myxoid matrix-producing tumor that often develops in the long bones of young adults. CMF is rarely reported in the craniofacial skeleton, with most cases presenting with bone erosion or destruction, which may lead to a misdiagnosis. To date, approximately 129 cases of CMF in the craniofacial region have been reported, with only three cases in patients aged less than 1 year. Of these 129 cases, only 34 affected the jaws. A 1-year-old boy presented with a mass in the left anterior maxilla, extending and compressing the ipsilateral nasal cavity. After surgical excision of the lesion, microscopy revealed spindle-to-stellate tumor cells surrounded by a predominant myxoid stroma containing focal slit-like vascular channels and hemorrhagic areas. Immunohistochemistry showed positivity for vimentin, CD10, and α-SMA (focal). The Ki-67 labeling index was 6%. CFM should be included in the differential diagnosis when assessing maxillary tumors in pediatric patients.

ARM: a modular hinged joint for the AO tubular external fixator.

Certain complex traumatic elbow lesions challenge the orthopaedic and trauma surgeon. If they are not treated correctly, they cause a high rate of disability, arising from elbow instablility and stiffness, either by fibrosis or joint incongruity. Injuries such as complex fractures of the proximal third of the ulna, coronoid fractures associated with radial head fractures (the "terrible triad"), are even worse if they are accompanied by soft tissue lesions. Hinged external fixators, complemented by other surgical procedures, are, for many, a recommended alternative when dealing with irreparable lesions. The AO tubular external fixator, by virtue of its versatility, is a very important tool in orthopaedics and trauma, but there is not the possibility of using it as a hinged fixator. The authors describe a prototype of a hinged joint that can be applied easily to the AO tubular external fixator, converting it into a hinged one. This hinged joint, in conjunction with the AO tubular external fixator, has been applied in 5 patients; 2 "terrible triads", one posterior elbow fracture-dislocation with radial head fracture, one Monteggia fracture-dislocation and an anterior elbow dislocation that developed a forearm compartment syndrome. The patients' age range was between 20 and 72 years (median 45,6); 4 were male and 1 female. In 3 patients, either a type III coronoid fracture or a radial head fracture, could not be repaired. One radial head was totally removed and another one partially removed. The remaining indications were because of severe soft tissue lesions. Results were evaluated using the Mayo Elbow Score Scale and the Broberg and Morrey radiographic evaluation scale. The median follow up was 18 months(range 6 to 48 months). All 5 patients got a maximum score of 100 points in the Mayo's Elbow Score Scale, indicating excellent results. No patient suffered elbow pain, or any type of elbow instability. The median range of motion in flexion was of 127.5 degrees (max. 140 degrees and min. 120 degrees ) and the median extension loss was 20 degrees (max. 25 degrees and min. 15 degrees ). One patient had pronation limited to 70 degrees and one had supination limited to 70 degrees . Every patient was able to resume a normal daily life activity and returned to normal work. In 3 patients the radiographic evaluation was Grade 0 and in the other 2, Grade I. Two complications occurred, one was a distal ulnar Schanz screw loosening with osteolysis and the other was a superficial infection of one Schanz screw. It can be concluded that good results can be obtained in injuries with severe elbow instability and soft tissue lesions, using this hinged external fixator. With this new clamp, the AO tubular external fixator is transformed into a hinged one and a new use is added to this already very versatile system. This clamp is very easy to apply.

Metastatic tumours in upper maxillary bone of esophageal adenocarcinoma. A case report.

Metastases in the oral cavity are rare lesions which represent approximately 1% of all malignant neoplasms in the oral cavity. Oral metastases are located in the mandible 80-90% on average, the maxilla location being rarer. Metastases in mouth soft tissue are also rare, and within these it is on the gums where they more frequently occur. Primary tumours which metastasize to mouth are most commonly: lung, breast and kidney. Oral cavity metastases appear as a result of distant disease spreading and show wrong prognosis, with short survival. Here we present a clinical case of a patient diagnosed with esophagus adenocarcinoma which presented metastasis in upper-left maxillary bone.

Pulsed electromagnetic stimulation of regenerate bone in lengthening procedures.

Distraction osteogenesis for limb lengthening represents the treatment of choice in patients with small stature or limb length discrepancies. Bone lengthening and callus formation requires a long therapy. Pulsed electromagnetic fields (PEMF) are normally used to enhance osteogenesis in patients with non-unions. In this study we investigated whether pulsed electromagnetic fields could be used effectively to encourage callus formation and maturation during limb lengthening procedures. Thirty patients underwent bilateral bone lengthening of the humerus, femur or tibia. At day 10 after surgery, PEMF stimulation was started on one side, for 8 hours/day. Stimulated distraction sites exhibited earlier callus formation and progression, and a higher callus density compared to non-stimulated sites. External fixation could be removed on average one month earlier in PEMF stimulated bones. Our results show that the use of pulsed electromagnetic fields stimulation during limb lengthening allows shortening the time of use of the external fixation.

Genetic structure and molecular variability of Cucumber mosaic virus isolates in the United States.

Cucumber mosaic virus (CMV) has a worldwide distribution and the widest host range of any known plant virus. From 2000 to 2012, epidemics of CMV severely affected the production of snap bean (Phaseulos vulgaris L.) in the Midwest and Northeastern United States. Virus diversity leading to emergence of new strains is often considered a significant factor in virus epidemics. In addition to epidemics, new disease phenotypes arising from genetic exchanges or mutation can compromise effectiveness of plant disease management strategies. Here, we captured a snapshot of genetic variation of 32 CMV isolates collected from different regions of the U.S including new field as well as historic isolates. Nucleotide diversity (π) was low for U.S. CMV isolates. Sequence and phylogenetic analyses revealed that CMV subgroup I is predominant in the US and further showed that the CMV population is a mixture of subgroups IA and IB. Furthermore, phylogenetic analysis suggests likely reassortment between subgroups IA and IB within five CMV isolates. Based on phylogenetic and computational analysis, recombination between subgroups I and II as well as IA and IB in RNA 3 was detected. This is the first report of recombination between CMV subgroups I and II. Neutrality tests illustrated that negative selection was the major force operating upon the CMV genome, although some positively selected sites were detected for all encoded proteins. Together, these data suggest that different regions of the CMV genome are under different evolutionary constraints. These results also delineate composition of the CMV population in the US, and further suggest that recombination and reassortment among strain subgroups does occur but at a low frequency, and point towards CMV genomic regions that differ in types of selection pressure.

Novedades en artroplastia de hombro en 2015 / Update in shoulder surgery 2015: arthroplasty

La indicación en la cirugía de sustitución protésica del hombro ha cambiado de una forma drástica en los últimos años, hemos pasado del tratamiento con prótesis parciales para fracturas agudas al uso de prótesis inversas, la prótesis anatómica ha perdido terreno hasta el punto de que en muchos hospitales la prótesis invertida ha superado con creces a la prótesis anatómica. También podemos decir que las indicaciones de prótesis han variado, así hemos ampliado el uso de la prótesis inversa que fue desarrollada para el tratamiento de las artropatías por manguito rotador. Estos implantes en la actualidad se usan además como recurso para fracturas y recambios. En este artículo intentamos hacer una puesta al día de los problemas más frecuentes de las artroplastias y además se hace una revisión de lo publicado en los últimos años haciendo mayor hincapié en los artículos publicados en el JSES, JBJS y los ICL de la AAOS. De forma resumida se valoran las complicaciones que afectan a las prótesis de hombro

Changes in replacement surgery in the shoulder have happened recently: reverse shoulder prosthesis for acute fractures, and more indications for reverse shoulder arthroplasty than before. In this paper an update of most frequent concepts in shoulder surgery during 2015 is performed

Treatment of diaphyseal humeral fractures with the minimally invasive percutaneous plate (MIPPO) technique: a cadaveric study and clinical results.

OBJECTIVES: To assess the clinical, functional and radiologic results of the minimally invasive percutaneous plate technique in the humerus. DESIGN: Retrospective study. SETTING: University-affiliated hospital center. PATIENTS/PARTICIPANTS: Eighty-six skeletally mature patients with humeral diaphyseal fractures requiring surgical stabilization. INTERVENTION: Treatment with locking compression plates using the minimally invasive percutaneous plate technique. MAIN OUTCOME MEASUREMENTS: Cadaveric study: distance between the plate and the neurovascular structures. Clinical outcome measurements included fracture healing, radial nerve palsy, infection, and elbow and shoulder discomfort. Radiographic measurements were time to healing, alignment, and nonunion. RESULTS: The minimum follow-up in all cases was 12 months, and all fractures except three healed. The main complications found were nonunion (three) and transitory radial nerve palsy (three). The patients recovered almost complete elbow and shoulder range of motion with 98% presenting good results; no patient had implant failure. CONCLUSIONS: The results obtained with this technique are encouraging. The technique was associated with no shoulder pain and an almost complete restitution of strength and articular range of motion. Within 6 months, 96% of the patients returned to their normal activities.

Reconstrucción mandibular con injerto costocondral en microsomía hemifacial: reporte de un caso / Mandibular reconstruction with a costochondral graft in hemifacial microsomia: report of a case

La reconstrucción de la articulación temporomandibular (ATM) es una de las cirugías más demandantes para el cirujano maxilofacial y su equipo. Sus objetivos no sólo incluyen la rehabilitación del complejo mecanismo normal de la articulación, sino también la restauración de la simetría facial, mejorar la oclusión y a la vez la masticación. Las funciones de la ATM pueden verse afectadas por diferentes en enfermedades: tumorales, infecciosas, traumáticas y displasias. Éstas son las que constituyen la mayor indicación para la reconstrucción de la ATM, siendo las congénitas asociadas a síndromes las más difíciles de tratar. La microsomía hemifacial es el segundo defecto craneofacial más común, después de la fisura labio palatina. Es un síndrome que, a diferencia de otros, presenta una gran diversidad de opciones de tratamiento, los cuales van a ser aplicados con un enfoque multidisciplinario, ya que los tratamientos pueden ir desde los conservadores o no quirúrgicos como los de ortopedia funcional hasta los quirúrgicos que comprenden la reconstrucción de la ATM y rama mandibular, los cuales en su mayoría se realizan con injertos libres costocondrales. Se presenta el caso de un paciente femenino de cinco años de edad, la cual acude referida al Hospital Central ®Dr. Ignacio Morones Prieto¼ con diagnóstico de microsomía hemifacial severa. Este trabajo se enfoca en describir el protocolo utilizado en nuestra institución para la reconstrucción mandibular de este síndrome desde edades tempranas, lo que beneficiará tanto la función articular como la estética facial.

Temporomandibular joint (TMJ) reconstruction is one of the most demanding surgical procedures performed by maxillofacial surgeons and their teams, whose aim is not only to rehabilitate the complex normal mechanism of the joint but also to restore facial symmetry, and to improve occlusion and chewing. TMJ functions can be affected by various types of maladies: tumors, infectious diseases, trauma, and dysplasias, which constitute the main indicators for TMJ reconstruction, being those associated with congenital syndromes the most difficult to treat. Hemi-facial microsomia is the second most common craniofacial defect after cleft lip and palate. Unlike other syndromes, it presents a wide range of treatment options, all involving a multidisciplinary approach as that they can range from conservative or nonsurgical procedures to functional orthopedics, and surgical procedures in which the TMJ and the mandibular ramus are reconstructed...

Verrucous carcinoma of the oral mucosa: An epidemiological and follow-up study of patients treated with surgery in 5 last years

INTRODUCTION: Oral Verrucous Carcinoma (OVC) is described apart of the Squamous Cell Carcinoma (SCC) due to its specific properties. The objective of our study is to show our series of cases of OVC and to compare with the SCC in terms of clinical manifestations, epidemiology, histopathology, treatment and follow-up. MATERIAL AND METHODS: This is a retrospective study of all the OVC treated in our department between January-2007 and December-2011. The analyzed variables were sex, age, localization in the oral cavity, histopathology, number of biopsies needed to diagnose OVC, TNM classification, treatment and recurrences during follow-up. RESULTS: Our sample was composed by n=14 patients, 57% female, with a mean age of 69.14 years. The most common localization was buccal mucosa (n=5). Seven patients were diagnosed of OVC with the first biopsy. TNM classification was: pT1: 7 patients, pT2: 3 patients, pT3: 3 patients, pT4: 1 patient. No cervical metastases were observed either in cervical neck dissection or during the follow-up of the patients. The treatment was surgery with clinical resection margins up to 1 cm in all cases, followed by radiotherapy in selected cases. Only n=1 patient (7.69%) presented a recurrence after 34 months of follow-up. The overall survival rate was 92.85%. CONCLUSIONS: In our population, OVC represents the 6.16% of all oral cavity and oropharynx cancer, and is more frequent in female patients above 70 years old. It uses to rise over a previous lesion, and usually affects the buccal mucosa. In patients with high suspicious lesions, more than one biopsy may be needed to diagnose OVC. No patient showed cervical dissemination. In our experience, treatment based on local resection, without cervical neck dissection, could be a good option for these patients (AU)

Metástasis en hueso maxilar superior de adenocarcinoma de esófago. Presentación de un caso clínico / Metastatic tumours in upper maxillary bone of esophageal adenocarcinoma. A case report

Las metástasis en cavidad oral son lesiones raras que representanaproximadamente el 1% de todas las neoplasias malignas decavidad oral. Las metástasis orales se localizan en un 80-90%en mandíbula, siendo mas raras en maxilar superior. Las metástasisen tejidos blandos de boca son raras, y es encía donde conmayor frecuencia se localizan las metástasis en tejidos blandosen boca. Los tumores primarios que metastatizan a boca son losmás frecuentes pulmón, mama y riñón. Las metástasis en cavidadoral es como consecuencia de una diseminación a distancia de laenfermedad e indica un mal pronóstico, con una supervivenciacorta. Aquí presentamos un caso clínico de un paciente diagnosticadode adenocarcinoma de esófago que presentó metastasisen hueso maxilar superior izquierdo

Metastases in the oral cavity are rare lesions which representapproximately 1% of all malignant neoplasms in the oral cavity.Oral metastases are located in the mandible 80-90% onaverage, the maxilla location being rarer. Metastases in mouthsoft tissue are also rare, and within these it is on the gumswhere they more frequently occur. Primary tumours whichmetastasize to mouth are most commonly: lung, breast andkidney. Oral cavity metastases appear as a result of distantdisease spreading and show wrong prognosis, with shortsurvival. Here we present a clinical case of a patient diagnosedwith esophagus adenocarcinoma which presented metastasis inupper-left maxillary bone